Ivar Lovaas, “Contrasting Illness and Behavioral Models for the Treatment of Autistic Children: A Historical Perspective,” 1979

Ivar Lovaas, “Contrasting Illness and Behavioral Models for the Treatment of Autistic Children: A Historical Perspective,” Journal of Autism and Developmental Disorders 9, no. 4 (1979):315-23.

Complete original source available here.

This excerpt offers a stark contrast between behaviorist and other perspectives on autism. Ivar Lovaas was one of the best known advocates of the behaviorist approach and an architect of early intervention known as Applied Behavior Analysis (ABA). Lovaas described his perspective as optimistic, practical, and inductive rather than disease-oriented. Instead of looking for the causes of autism in children’s brains, or in disordered parent-child relationships, behaviorists emphasized what autistic children had in common with all normal as well as other developmentally disabled children and adults: the ability to learn and grow in response to their social environments.

Ivar Lovaas (courtesy of Lovaas Institute)

It is the purpose of these comments to provide a brief history of the behavioral approach to the treatment of autistic children, and to define certain important features of that approach. To do so, it may be helpful to contrast the two main approaches that have been applied to the study and treatment of autistic children…. The two approaches or models can be referred to as the “disease” or illness model and the learning or “behavioral” model.

According to the disease model, there exists an illness labeled autism, and the child’s behaviors are considered symptoms or expressions of this underlying problem. Two main schools of thought feed into this disease model. One school, centering on Freud and psychodynamic theory, postulates illness caused by environmental factors, such as abnormal parent-child relationships. The other school of thought springs from organic psychiatry, which postulates an illness caused by nutritional, genetic, or traumatic injury to the nervous system….

With the disease model, treatment is focused on identifying and removing “autism.” …. The child’s behavior as such is not considered the prime target for intervention….

The problem is that the disease model of autism has failed both in identifying the cause of autism and prescribing an effective treatment for such children….

The behavioral model that Ferster helped start was to draw heavily on experimental psychology…. In a nutshell, the new movement broke the big problem (“autism”) down into smaller conceptual problems and went to work with improved research design….

Ferster (1961) argued essentially that the autistic child’s behavioral deficiency could be understood as based on the failure of social stimuli to acquire reinforcing (rewarding) properties for them…. We become human to the extent we are affected by the people (society) around us…. Ferster and DeMyer (1961, 1962) reported a series of experiments in which autistic children were exposed to very simple but highly structured environments in which they learned very simple behaviors, such as pulling levers and matching forms, for effective reinforcements such as food. These were very important experiments because they showed that the behavior of autistic children may be understood according to certain laws of learning from experimental psychology and may be helped by that body of information….

The success of the behavioral approach in building language in previously mute and echolalic children is one of its most significant achievements….

Certain major problems remain. One such problem pertains to the situationality and reversability of most treatment gains. Another problem pertains to the slow change with treatment; it is hard work to treat autistic persons….

Many behaviors remain that are not very well understood. For example, not much is known as yet about how to teach play…. Another area that has not been explored systematically relates to the teaching of feeling and emotions….

The programs developed to teach autistic children to dress, eat, toilet themselves, talk, or better manage their tantrums, etc., were immediately useful to retarded children, and vice versa. In general, it appears that the behaviors of autistic children are not radically different from those of many other children, be they normal, aphasic, blind, hyperactive, etc…. What has emerged, it seems, is an expertise in dealing with different kinds of behaviors….

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